0404-001 (RC) LICENSED CONTRACTOR DECLARATION PERMIT# /
_ I I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
H ' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT 044-081 TRACT
N W Professionals Code,and my License is in full force and effect. 049)6t2(X 52. A14AU
O =) C) License# Lic.Class Exp.Date
W r J•3tt:�rt7 �S?_'.•.2fj n7jz8f2! ADDRESS 78-tlflf1A'4 -WITF■#7 ST T11':#2(Xt PN -
ZO Date rf^ '` Signature of Corltrnior f OWNER CONTRACTOR/DESIGNER/EN INEER
CD
J U C) OWNER-BUILDER DECLA�N==� VISTA i.,A QWWA,11.1t:' LATH}ZOF D1;;Vc1_AJF'IVlF:W,
H LLla I hereby affirm under penalty of perjury that'l✓am exempt from the Contractor's 72.912 Wl.fleOW ST, 72.912 WTI LOW 19TIr.>iIY-T
U License Law for the following reason: I..A QUINTA CA !4283 PALMDEMT CA 42260
Z ( ) I, as owner of the property, or my employees with wages as their sole (760)346-5020 C.B1 0 314
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed COWAMCMAL REMODEL
contractors to construct the project (Sec. 7044, Business & Professionals IIIIII�IIIIIIIIIIIIIIIIII
Code). COMMLRCLAL OMCL TI Q&"SQIrI',-B-OCCUPANCY,TYPE VN 40
Cl) O I am exempt under Section a&P.C.for this reason 9PRINKL$D,OCCUPANT LOAD 19,2001 CBC IE
N Date Signature of Owner
ON
Q,
d Q WORKER'S COMPENSATION DECLARATION
C) 2
I hereby affirm under penalty of perjury one of the following declarations: VALUATION 23,33 ,40 LS
r- F-.; O ( ),A have and will maintain a certificate of consent to self-insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C0 Q U ( ) I have and will maintain workers'compensation insurance, as required by
O L Q Section 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v z Carrier STATE FUND Policy No. 0411-001091x3 ISTU"ED COST O]`CtUT',46=cnQPT 2:1,334,104
°r° O PAMMM Tl1'M SlLiMWARY
Q (This section need not be completed if the permit valuation is for$100.00 or less). PLAN CHECK 101.000-439.318 :1'.17,95
%. J ( ) I certify that in the performance of the work for which this permit is issued, CONS"Pl?.UCTION Ft9 101-OW-418-000
I shall not employ any person in any manner so as to become subject to the UNCH"CAL PEE 101.000421-000
workers' compensation laws of California, and agree that if I should become ELMMICAL M 101-000-420-000
subject to the workers'compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. PLUUBINO FEE 101-000-419.000 X17,00
Date: K.. Applicant STRO?44 MOTION IME•COMM 100-000-241-000 $4.90
• Warning: Failure to secure Work rs' Compensation coverage is unlawful and
shall subject an employer to crimin 15'enalties and civil fines up to$100,000,in
addition to the cost of compensati In Aamages as provided for in Section 3706
of the Labor Code,interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1.Each person upon whose behalf this application is made&each person at ; OTA::Tcda _qt'51;1'STxi.If,"TI0N PRE,-k 11-M CHM;K $524.41
whose request and for whose benefit work is performed under or pursuant to LF.'IST7F11„ A� �� $f),
any permit issued as a result of this applicaton agrees to, &shall, indemnify "_I ,
00
& hold harmless the City of La Quinta, its officers, agents and employees. i
2.Any permit issued as a result of this application becomes null and void if WMAL Pll'1tM1'1')h' EN D1 TK T'4OW $524.41
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation. f
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and.St9to laws relating to the building
construction, and hereby authorize-represen.tadtives of this City to enter upon ✓/
the above-mentioned property for inspection purposes.
RECEIPT DATE 13 DATE Flp{ ED INSPE OR
Signature (Owner/Agent) �” Date,/,;'!.,/, sr -.` , % 4/ S
i
9
y
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K.to Wrap F.A.U.
Framing Zp Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fans 8 Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall-Int.Lath
Final
Final POOLS - SPAS
BLOCKWALL APPROVA S Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg.Test
Final I Gas Piping
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines Heater Final
Water Piping Plumbing Final
Plumbing Top Out —Ti YJAM.S 4Z;16+ Equipment Enclosure
Shower Pans O.K.for Finish Plaster
Sewer Lateral Pool Cover
Sewer Connection Encapsulation
Gas Piping
Gas Test
Appliances
" Final
COMMENTS:
Final
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp.Power Pole
Underground Conduit
Rough Wiring 'r io o
Low Voltage Wiring
Fbetures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp.Use of Power ,s
Final
Utility Notice(Perm)
�� IIIIIIIIIIIIIIIIIII II 41
i K
'Certificate of Occupancy
jNCpPOi�7FD
1. f WR
'Cc
OF9 Building .& Safety Department g r
5
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
x ; provisions of .the Building Code and the various ordinances of the City regulating building ` r'
a ,
F .
construction and/or use. a:
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BUILDING ADDRESS: 78-900 Avenue 47 Suite 200 m i
; ur Use classification: Commercial (Office TO Building Permit No.: 0404-001
` Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR k
Y
Owner of Building: Vista La Quinta, LLC Address: 72912 Willow Street
City, ST, ZIP: La Quinta, CA 92253
yDaniel P. Crawford Jr.
Date: 5/28/04 `
Building Official
POST IN A CONSPICUOUS PLACE '
call�i�.wc�`L•c Certificate
of Occupancy
.
I�cowoxrm�
set
OF �ti Building & Safety Department
This Certificate is issued pursuant to the requirements.of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 78-900 Avenue 47 Suite 200
Use classification: Commercial (Office TO Building Per No.: 0404-001
Occupancy Group: B- Type of Construction: VN Sprinkled Land Use Zone: CR
Owner of Building: Vista La Quinta. LLC Address: 72912 Willow Street
City, ST, ZIP: La Quinta, CA 92253
d By: Daniel P. Crawford Jr.
Date: 5/28/04
'Building. -,
POST IN A CONSPICUOUS PLACE
i